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The Relationship Between Vitamin D Deficiency and Thyroid Function in the First Trimester of Pregnancy

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The Relationship Between Vitamin D Deficiency and Thyroid Function in the First Trimester of Pregnancy Original Article The relationship between Vitamin D deficiency and thyroid function in the first trimester of pregnancy Farahnaz Rostami 1, Lida Moghaddam-Benaem2, Navid Ghasemi 3, Sedighe Hantoushzadeh 4* 1Department of Midwifery & Reproductive Health, Faculty of Medical Sciences, Tarbiat Modares University, Al-e-Ahmad Highway, Tehran, Iran. 2 Department of Reproductive Health & Midwifery, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. 3 Department of medicine, faculty of Medical Sciences Tehran, Islamic Azad University, Tehran, Iran.4 Maternal, fetal & Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Abstract Aims and Objective: There are few studies about the relationship between vitamin D deficiency and thyroid hormone levels in pregnancy. This study aimed to assess the relation serum vitamin D levels with thyroid hormones in the first trimester of pregnancy in Iran. Methods: In this case-control research 430 pregnant women (215 mothers with vitamin D deficiency, and 215 without this deficiency) attending prenatal clinics in Tehran, Iran were studied. 25 hydroxy vitamin D levels and thyroid function tests [free tetraiodothyronine (FT4), thyroid stimulating hormone (TSH), and free triiodothyronine (FT3)] were measured in all mothers. Data were analyzed using SPSS version 22 software. Kolmogorov-Smirnov test was used for normality testing of continuous variables; Student T-Test, and Mann-Whitney U test were used to compare the continuous parametric and nonparametric variables respectively in the 2 study groups; Linear regression model was used to assess the effect of potentially effective variables besides vitamin D on thyroid function tests. Results: In Mann-Whitney U test performed, T4 levels (mean± SD) were significantly higher in vitamin D deficiency group compared with the control group (20.8 ±32.5 vs.14.4 ± 24.1 ng/dl, P-value: 0.04), but there were no significant differences between the 2 study groups regarding TSH, and free T3 levels. In Linear regression analysis, assessing the effects of vitamin D deficiency plus maternal age, Body Mass Index, and number of pregnancies on thyroid function tests, it was shown that vitamin D deficiency had only a significant direct relation with free T4 levels (β: 0.122, P-value: 0.01), but had no significant relations with the other thyroid function tests namely TSH, and free T3. Conclusion: A significant direct relationships were observed between Vitamin D deficiency with the level of thyroxin (T4) during early pregnancy. higher levels of T4 in vitamin D deficient mothers. Due to the negative effects of Vitamin D deficiency and thyroid hormones on the mother and fetus, further studies should be conducted which may help in more accurately screening during pregnancy. Keywords: Vitamin D, Vitamin D deficiency, Thyroid function, Pregnancy. important point here is that both vitamin D and thyroid INTRODUCTION hormones, attach to similar receptors called steroid hormone receptors. On the other hand, a kind of gene in the Vitamin D Vitamin D is a fat-soluble vitamin and a steroid hormone, receptor has been shown to predispose persons to which its main role is calcium and bone metabolism. The autoimmune thyroid disease. Therefore, any change in deficiency of this vitamin is known as a worldwide problem. vitamin D levels may increase the risk of thyroid Evidence has shown that vitamin D deficiency may increase the risk of a wide range of chronic diseases. Also, its deficiency can increase the likelihood of autoimmune Address for correspondence: Mrs. Sedighe Hantoushzadeh, Maternal, fetal & Neonatal Research Center, Tehran University diseases, upper respiratory tract infection, diabetes, of Medical Sciences, Tehran, Iran. [1] cardiovascular disease, and cancer . Email: [email protected] This vitamin is active in the immune system and its role as a This is an open-access article distributed under the terms of the Creative Commons modulator of the immune system has recently been Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, [2] highlighted Several clinical trials have shown that tweak, and build upon the work noncommercially, as long as the author is credited autoimmune diseases such as lupus erythematosus, [3] and the new creations are licensed under the identical terms. Multiple sclerosis[4], Rheumatoid arthritis, [5] Hashimoto's thyroiditis, and hypothyroidism are associated with vitamin How to cite this article: Rostami, F., Moghaddam-Benaem, L., D deficiency. [6] Ghasemi, N., Hantoushzadeh, S. The relationship between Vitamin D deficiency and thyroid function in the first trimester of pregnancy. Arch Pharma Pract 2020;11(S1):132-7. Vitamin D receptors are present in various tissues of the body such as pancreas, thyroid gland, and myocardium, etc. [7] The © 2020 Archives of Pharmacy Practice 1 131 Rostami et al.: The relationship between Vitamin D deficiency and thyroid function in the first trimester of pregnancy abnormalities. For these reasons, it is important in patients This case-control study was conducted on 450 pregnant with thyroid disease to understand the effects of Vitamin D women in their first trimester of pregnancy in a referral on health. [8, 9] The main mechanisms of the role of vitamin D prenatal clinic (which admitted patients from all over the city) in autoimmune diseases have not been fully understood but in Tehran, Iran during September 2017 – 2018. In this clinic in a clinical trial with a review of vitamin D receptor (VDR) measurements of calcium and vitamin D levels were in patients with thyroiditis, increased thyroid disease risk was performed as part of routine prenatal laboratory tests for all shown.[10] Recent evidence demonstrates the relationship pregnant women in their first trimester of pregnancy. 215 between vitamin D and Hashimoto thyroiditis and Graves ' pregnant women who had vitamin D levels lower than 30 disease. Vitamin D may have a role in thyroid diseases, ng/ml were recruited in the study as the case group, and 215 including thyroiditis and thyroid carcinoma.[11] It was also mothers with normal vitamin D levels (equal to or higher than seen that Vitamin D deficiency, especially the amounts of less 30 ng/ml) were recruited as the control group.[28] than 12.5 ng/ml, was considered as a risk factor for autoimmune disease and thyroid disease.[12] Besides, an Inclusion criteria in the study were: age 18-40 years, increased level of TSH was observed after the administration gestational age less than 14 weeks, not have a chronic disease, of vitamin D supplements. [13] Another study reported the and malabsorption, single pregnancy, not taking any effect of pregnancy suppressant on thyroid parameters supplements except multivitamins, and Iranian nationality. (thyroxin (T4) hormone triiodothyronine (T3) and thyroid- stimulating hormone (TSH)).[14] Controls and cases were matched by frequency matching method in terms of age, number of pregnancies, age of Even though many studies have evaluated the role of vitamin marriage and body mass index (BMI). D in thyroid disease, few studies have investigated the effects of 25-hydroxy vitamin D on thyroid hormones in pregnancy Exclusion criteria were, the unwillingness of mothers to and their effects on maternal and fetal health. [15-17] Pregnancy continue participation in the study, mothers who had a may be associated with changes in iodine homeostasis and vegetarian diet or a special diet, mothers who had other physiological changes that eventually lead to altered hypothyroidism before pregnancy and used levothyroxine thyroid function. [18] Maternal thyroid function should be tablets during Pregnancy. maintained normally, especially in the first trimester. In the first trimester, the fetus is fully dependent on maternal thyroid All eligible mothers were enrolled after being given complete hormones for brain development. [19] Several studies have information about the study, and signing the informed shown that vitamin D deficiency and thyroid function can consent until the sample size was completed. They also lead to a series of adverse complications during pregnancy, completed their sociodemographic and obstetric including gestational hypertension [20, 21] preeclampsia [22, 23] questionnaire. Preterm delivery [21, 24] intellectual and neurological growth disorder in children [17, 25] and so on. Therefore, to maintain a Measurement healthy pregnancy and normal fetal skeletal development and Vitamin D was measured by ELISA method using MAN Co to prevent preeclampsia, an optimal vitamin D level should Kit. Thyroid function tests (T3, T4, TSH) were conducted by [26] be maintained to ensure fetal health. Also hypothyroidism Roche ELISA Modular Analytics Cobas e411 (kit Roche is common in pregnant women, and if screening is performed Diagnostics, Mannheim, Germany) at Nilou Laboratory. only in high-risk groups, 25% of pregnant women with Mothers' weight and height were measured at the first subclinical and hidden hypothyroidism are not explicitly prenatal visit using unique tools for all participants. Body [27] diagnosed. Mass Index (BMI) was calculated by dividing weight (kg) on height2 (m2). Objectives Given the rather high prevalence of vitamin D deficiency and Sample size thyroid disorders in Iran, and their adverse effect on the Convenience sampling was performed and the sample size maternal and fetal outcomes of pregnancy, and also lack of was calculated through the Pokak formula,[29] having sufficient evidence
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